title: Differences in outcomes of newly diagnosed acute myeloid leukemia for adolescent/young adult and younger patients: a report from the Children's Oncology Group.
abstract: BACKGROUND
  Studies comparing survival of adolescent and young adult (AYA) patients to that of younger patients with newly diagnosed acute myeloid leukemia (AML) have yielded conflicting results. In order to more accurately characterize relative survival and other outcomes of AYA patients, a cross-study analysis was conducted using data from recent trials conducted by the Children's Cancer Group (CCG) and Children's Oncology Group (COG).
  
  
  METHODS
  Data were combined from the CCG-2891, CCG-2941, CCG-2961, and AAML03P1 trials. The data set included 1840 patients, comprising 238 AYA and 1602 younger patients.
  
  
  RESULTS
  Overall survival was not significantly different in the 2 groups (AYA, 49% ± 7% versus younger, 54% ± 3% (± 2 standard errors), P = .058). Relapse was lower in AYA patients (30% ± 7% versus 41% ± 3%, P = .002), but treatment-related mortality (TRM) was higher (25% ± 6% versus 12% ± 2%, P < .001). After adjustment for other factors, older age remained strongly associated with TRM (hazard ratio = 2.30, 95% CI = 1.59-3.33, P < .001). Infection accounted for the excess TRM in AYA patients.
  
  
  CONCLUSIONS
  Survival in AYA and younger patients with newly diagnosed AML is similar; however, older patients are at higher risk for TRM. More effective strategies for preventing mortality from infection in AYA patients are needed.
authors.affiliation: Advocate Hope Children's Hospital, Oak Lawn, Illinois.
authors.forename: Jason
authors.initials: J
authors.lastname: Canner
authors.forename: Todd A
authors.initials: TA
authors.lastname: Alonzo
authors.forename: Janet
authors.initials: J
authors.lastname: Franklin
authors.forename: David R
authors.initials: DR
authors.lastname: Freyer
authors.forename: Alan
authors.initials: A
authors.lastname: Gamis
authors.forename: Robert B
authors.initials: RB
authors.lastname: Gerbing
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Lange
authors.forename: Soheil
authors.initials: S
authors.lastname: Meshinchi
authors.forename: William G
authors.initials: WG
authors.lastname: Woods
authors.forename: John
authors.initials: J
authors.lastname: Perentesis
authors.forename: John
authors.initials: J
authors.lastname: Horan
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality* / Q000628:therapy; D008297:Male; D055815:Young Adult
keywords: acute myeloid leukemia; adolescent and young adult; cancer; children; infection